Provider Demographics
NPI:1619392396
Name:ROMAN, MELISSA EVE (EMT-P)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:EVE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:EMT-P
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:EVE
Other - Last Name:HEIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BLDG 301 ANDREWS AVE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7409
Mailing Address - Fax:
Practice Address - Street 1:BLDG 301 ANDREWS AVE
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344573146L00000X
AL1500112146L00000X
NYP8067260146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic